Dr. Chari on the Role of MRD Testing in Multiple Myeloma

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Ajai Chari, MD, discusses recommendations for minimal residual disease testing in patients with multiple myeloma.

Ajai Chari, MD, professor of medicine, director of clinical research in the multiple myeloma program, and hematologic oncologist at Mount Sinai Hospital, discusses recommendations for minimal residual disease (MRD) testing in patients with multiple myeloma.

It is important to ensure that serologic tests are negative in the blood and urine, radiologic tests are negative, bone marrow tests are good quality, and other analytic characteristics are accurate, according to Chari. Additionally, the sensitivity of these tests needs to be adequate, at either 10-5 or 10-6. Suboptimal tests should not be used to inform treatment decisions, Chari says. Furthermore, if there no predictive data are available, these tests will often not impact the management of patients, except for in extreme cases, Chari adds.

Additionally, sustained MRD status is crucial in making treatment decisions for patients, and adequate follow-up is needed, Chari adds. For example, the phase 2 FORTE trial (NCT02203643), which examined induction with the combination of carfilzomib (Kyprolis), lenalidomide (Revlimid), dexamethasone followed by maintenance with either carfilzomib plus lenalidomide or lenalidomide alone, showed that the study arms were not as comparable as originally reported. This emphasizes the need for longer follow-up to make appropriate therapeutic decisions, Chari concludes. 

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